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dc.contributor.authorNedberg, Ingvild Hersoug
dc.contributor.authorManjavidze, Tinatin
dc.contributor.authorRylander, Charlotta
dc.contributor.authorBlix, Ellen
dc.contributor.authorSkjeldestad, Finn Egil
dc.contributor.authorAnda, Erik Eik
dc.date.accessioned2022-11-08T13:10:50Z
dc.date.available2022-11-08T13:10:50Z
dc.date.issued2022-07-19
dc.description.abstractBackground<p> <p>There is little research on how financial incentives and penalties impact national cesarean section rates. In January 2018, Georgia introduced a national cesarean section reduction policy, which imposes a financial penalty on hospitals that do not meet their reduction targets. The aim of this study was to assess the impact of this policy on cesarean section rates, subgroups of women, and selected perinatal outcomes. <p>Methods <p>We included women who gave birth from 2017 to 2019 registered in the Georgian Birth Registry (n = 150 534, nearly 100% of all births in the country during this time). We then divided the time period into pre-policy (January 1, 2017, to December 31, 2017) and post-policy (January 1, 2018, to December 31, 2019). An interrupted time series analysis was used to compare the cesarean section rates (both overall and stratified by parity), neonatal intensive care unit transfer rates, and perinatal mortality rates in the two time periods. Descriptive statistics were used to assess differences in maternal socio-demographic characteristics. <p>Results <p>The mean cesarean section rate in Georgia decreased from 44.7% in the pre-policy period to 40.8% in the post-policy period, mainly among primiparous women. The largest decrease in cesarean section births was found among women <25 years of age and those with higher education. There were no significant differences in the neonatal intensive care unit transfer rate or the perinatal mortality rate between vaginal and cesarean section births in the post-policy period. <p>Conclusion <p>The cesarean section rate in Georgia decreased during the 2-year post-policy period. The reduction mainly took place among primiparous women. The policy had no impact on the neonatal intensive care unit transfer rate or the perinatal mortality rate. The impact of the national cesarean section reduction policy on other outcomes is not known.en_US
dc.identifier.citationNedberg, Manjavidze, Rylander, Blix, Skjeldestad, Anda. Changes in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017-2019. PLOS ONE. 2022;17(7)en_US
dc.identifier.cristinIDFRIDAID 2044476
dc.identifier.doi10.1371/journal.pone.0271491
dc.identifier.issn1932-6203
dc.identifier.urihttps://hdl.handle.net/10037/27300
dc.language.isoengen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.journalPLOS ONE
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2022 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0en_US
dc.rightsAttribution 4.0 International (CC BY 4.0)en_US
dc.titleChanges in cesarean section rates after introduction of a punitive financial policy in Georgia: A population-based registry study 2017-2019en_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's license is described as Attribution 4.0 International (CC BY 4.0)